Hyperostotic chronic sinusitis as an indication for outpatient intravenous antibiotics

There is a subset of patients with chronic rhinosinusitis (CRS) that demonstrate osteitis of the sinuses. Osteitic bone is evident on computed tomography (CT) as hyperostosis. We propose treatment of this entity with a six week course of outpatient intravenous antibiotics in an approach similar to that used in the orthopedic literature for long bone osteomyelitis. This group of patients can be identified based on symptoms, unremitting course of disease, and imaging criteria. Although indications for the use of outpatient intravenous antibiotics must be determined judiciously in CRS we believe that hyperostotic sinusitis is an additional indication.

A retrospective chart review.

A retrospective chart review of ten patient with hyperostotic sinusitis treated over a three year period (1/2007- 8/2009).

Ten patients (age range, 25-85) with hyperostotic sinusitis were identified and quality of life was evaluated with SNOT-22. All patients underwent both pre- and post- treatment nasal endoscopy and CT. All patients underwent revision surgery by senior author (VKA). Five patients were treated with 6 weeks of intravenous antibiotics. Antibiotic choices were culture directed and antibiotics administered included Cefazolin, Clindamycin, Ertapenem, Maxipime, and Vancomycin. Minor complications encountered during therapy included: paresthesias and elevated liver enzymes. Five patients, (serving as the control group), were treated with traditional therapy involving intermittent and prolonged courses of oral antibiotics.

Prolonged intravenous antibiotics may achieve adequate serum levels that cannot be achieved with oral antibiotics. Symptomatic relief in patients with hyperostotic sinusitis appears superior with intravenous antibiotics versus traditional oral therapy. Indications for intravenous antibiotics should include hyperostotic sinusitis.